Provider Demographics
NPI:1699276048
Name:ELDER, LESLIE BRANDON (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:BRANDON
Last Name:ELDER
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 W CROSSVILLE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7510
Mailing Address - Country:US
Mailing Address - Phone:404-547-0825
Mailing Address - Fax:770-783-6618
Practice Address - Street 1:570 W CROSSVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7510
Practice Address - Country:US
Practice Address - Phone:404-547-0825
Practice Address - Fax:770-783-6618
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist